Quality indicators in the early detection of cervicouterine-cancer in primary health care units
Main Article Content
Keywords
Uterine cervial neoplasms, Vaginal smears, Quality indicators, health care
Abstract
Background: to determine the quality of a prompt cervical cancer detection program (TDC CC) according to the indicators for prevention and diagnosis.
Methods: cross-sectional and comparative study conducted in four primary care units. We selected 400 patients who attended preventive services to participate in the study of cervical cytology (Pap). The evaluation of the Program of TDC CC was obtained by the degree of fulfillment of quality and productivity outlined by an institutional program. The seven indicators were measured by the same scale. A descriptive statistics, adjusted kappa, and chi square with a level of significance of 95 % confidence interval was used.
Results: the average age was 40 ± 12.6 years. Most women (92.5 %) had information about the Pap screening method in CC, even thought only 25.3 % had this test done in the last three years. The inter-observer agreement was scored low by three cytotechnologists. The degree of compliance according to indicators of the 4 units was 35.7 %, and was rated as moderate. The best indicators were great productivity among cytotechnologists, the number and proportion of re-examined cytologies.
Conclusions: most indicators were below the expected values.
References
Ferlay J, Parkin DM, Bray F, Pisani P. GLOBOCAN 2002. Cancer incidence, mortality and prevalence worldwide. IARC. Cancer Base No. 5, Version 2.0. Lyon: IARC Press; 2004.
Arrossi S, Sankaranarayanan R, Parkin DM. Incidencia y mortalidad del cáncer cervical en América Latina. Salud Publica Mex 2003;45(Suppl 3):S306-S314.
Secretaría de Salud. Registro histopatológico de neoplasias en México. México: DGE/SSA; 1999.
American Cancer Society. Cancer facts y figures, 2002. Atlanta: American Cancer Society; 2009. Disponible en http://getyourscreentest. com/downloads/STT/500809 web.pdf
Sankaranarayanan R, Budukh Atur Madhukar, Rajikumar R. Programas eficaces de cribado del cáncer cervicouterino en los países en desarrollo de ingresos bajos y medios. Bull World Health Org [revista en línea] 2001;79(6):654-962. Dispo- nible en http://www.scielosp.org/scielo.php?script =sci_arttext&pid=S0042-96862001001000009&lng =es.doi:10.1590/S0042-96862001001000009
Modificación a la Norma Oficial Mexicana NOM-014-SSA2-1994 para la Prevención, Control y Tratamiento del Cáncer de Cuello del Útero. Diario Oficial de la Federación del 6 de marzo de 1998.
Rodríguez-Reyes R, Cerda-Flores R, Quiñones-Pérez J, Cortés-Gutiérrez E. Evaluación del programa de Detección Oportuna del Cáncer Cervicouterino (DOC) en Durango, México. Ginecol Obstet Mex 2002;70(1):3-6.
Salinas-Martínez A, Villareal-Ríos E, Garza-Elizondo M, Faire-Gloria JM, López-Franco JJ, Barboza-Quintana O. Calidad del Programa de Detección Oportuna de Cáncer Cervicouterino en el estado de Nuevo León. Salud Publica Mex 1997;39(3):187-194.
Lazcano-Ponce E, de Ruiz PA, López-Carrillo L, Velázquez-Manríquez ME, Hernández-Ávila M. Quality control study on negative gynecological cytology in Mexico. Diagn Cytopathol 1994;10:10-14.
Lazcano E, Nájera P, Alfonso P, Bulatti E, Hernán-dez-Ávila M. Programa de detección oportuna del cáncer cervical en México I. Diagnóstico situacional. Rev Inst Nac Cancerol 1996;42(3):123-140.
Lazcano-Ponce E, Rojas-Martínez R, López-Acuña MP, López-Carrillo L, Hernández-Ávila M. Factores de riesgo reproductivo y cáncer cervicouterino en la Ciudad de México. Salud Publica Mex 1993;35 (1):65-73.
Zoorob R, Anderson R, Cefalu Ch, Sidani M. Cancer screening guidelines. Am Fam Physician 2001; 63(6):1101-1012.
Bray F, Loos AH, McCarron P, Weiderpass E, Arbyn M, Moller H, et al. Trends in cervical squamous cell carcinoma incidence in 13 European countries: changing risk and the effects of screening. Cancer Epidemiol Biomarkers Prev 2005; 14(3):677-686.
Cox JT. ASCCP practice guidelines: management issues related to quality of the smears. Lower Genital Tract Dis 1997;1:100-106.
Palacio MLS, Rangel-Gómez G, Hernández-Ávila M, Lazcano-Ponce E. Cáncer cervical, una enfermedad de la pobreza: diferencias en la mortalidad por áreas urbanas y rurales en México. Salud Publica Mex 2003;45(Supl 3):315-325.
Hernández HDM, Linaldi YF, Apresa GT, Escudero RP, Alvarado CI, Ornelas BL, et al. Indicadores de uso y motivos de incumplimiento para tamizaje en cáncer de cérvix. Rev Med IMSS 2010. [En prensa.]
Sankaranarayanan R, Rajkumar R, Arrossi S, Theresa R, Esmy PO, Mahe C, et al. Determinants of participation of women in a cervical cancer visual screening trial in rural south India. Cancer Detect Prev 2003;27(6):457-465.
Nájera-Aguilar P, Lazcano-Ponce E, Alonzo-de Ruiz P, Ramírez-Sánchez T, Cantoral-Uriza L, Hernández-Ávila M. Factores asociados con la familiaridad de mujeres mexicanas con la función del Papanicolaou. Bol Oficina Sanit Panam 1996; 121(6);536-542.
Instituto Nacional de Estadística, Geografía e Informática. XII Censo Nacional de Población y Vivienda, 2000. México: INEGI; 2001.
Leyden WA, Manos MM, Geiger AM, Weinmann S, Mouchawar J, Bischoff K, et al. Cervical cancer in women with comprehensive health care access: attributable factors in the screening process. J Natl Cancer 2005;97(9):675-683.
Rothman KJ, Greenland S. Precision and validity in epidemiologic studies. En: Rothman KJ, Greenland S, editors. Modern epidemiology. Second edition. Philadelphia, USA: Lippincott-Raven; 1998. p. 115-119.
Waxman, AG. Guidelines for cervical cancer screening: history and scientific rationale. Clin Obstet Gynecol 2005;48(1):77-97.
Instituto Mexicano del Seguro Social. Coordinación de Salud Comunitaria. Programa de prevención, detección y control del cáncer cervicouterino. México: IMSS; 2005.
Kant AC, Palm BT, Dona DJ, Makkus AF, Vooijs GP, Van Weel C. Cellular composition of cervical smears taken by general practitioners. Int J Q Health Care 1995;7(1):11-16.